|Year : 1958 | Volume
| Issue : 1 | Page : 15-16
Woman's hair for sclero-corneal sutures in cataract surgery
M. G. M. Medical College, Indore, India
|Date of Web Publication||8-May-2008|
D P Agarwal
M. G. M. Medical College, Indore
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Agarwal D P. Woman's hair for sclero-corneal sutures in cataract surgery. Indian J Ophthalmol 1958;6:15-6
One of the earliest materials used for applying corneal or corneo-scleral stitches in eye-surgery was woman's hair and it is a matter of regret that such a simple, romantic, indigenous material, so readily available has lost interest with ophthalmologists of today.
The material is always free and freely available, easily sterilisable, physiologically acceptable and not irritable to the ocular tissues. On enquiring from those who once used the material and have given up its use, the reasons for discontinuation given are as follows
2.Fear of impurities and of doubtful sterility.
3.Obstinately stiff and therefore not easily manoeuvred.
4.Not easy to tie a knot with.
All of these objections can easily be answered. Woman's hair like woman herself is tickle, and so the choice of donor material must be rigid and the same donor may then always be tapped. It offers a wonderful opportunity for a little bit complementation to the fair sex. Because the stitch has to be long, the hair has got to be a woman's unless it is a Sikh's.
Black hair is always thicker and stronger than a blond one and so the ophthalmologist must search for a brunette but not one with curly hair. The tension of such a hair can easily be tested by stretching it and the subject whose hair can easily break will lose in this our trial of choice. So, all hail the brunette with strong straight hair, preferably with some kind of a bob, for it is common knowledge that cut hair grow stronger. Objection I is thus answered.
Hair are lubricated and given a shine with oily medications natural (sebaceous material) and artificial. The best solvent for grease is soap and water and alcohol or ether and storage of hair in ether or 70% alcohol or formalin vapour after washing with soap and water removes all the grease from the hair, sterilises it and prepares it for further sterilization with ordinary boiling, as in the case of silk or any other suture material, except catgut. Objection 2 is untenable.
Wet hair loses its stiffness and so when used wet is an answer to the remaining two objections. In certain respects a little bit of stiffness is desirable especially in cases of a cut corneo-scleral stitch. Its stiffness makes the cut end emerge from the track when the uncut end is pushed steadily in the direction of the cut end.
So the objections are not nearly so formidable. Nobody has yet prepared a hair suture with an atraumatic needle otherwise that would be even better.
As regards the application of the sutures there can be a modification by every imaginative surgeon. Corneo-scleral sutures fall under two main groups - preplaced and postplaced. We prefer the preplaced variety because there is better anatomical apposition of the opposing edges of the wound, and the least time is spent in the closure of the wound after delivery of the lens.
These again are used with or without a conjunctival flap, which may be limbal-based or fornix-based.
After giving a trial to all the known varieties of suturing I have finally come to adopt the following modification as my pet method. The needle is first passed at the 12 o'clock position, perpendicular to the limbus about 4 mm. above it through the conjunctiva, superficial layers of the sclera and out through the conjunctiva about 2mm. above the limbus. It is reinserted in the same line at the limbus, through the superficial layers of the cornea and out again about 2 mm. below the limbus. As there is a space of about. 2 mm. in between the two limbs of the suture loop there is no danger of cutting it with the cataract knife and as a conjunctival flap is not reflected over the cornea there is no obscuration of the final manoeuvres of the cataract knife which must be brought accurately through the deeper parts of the limbus at the site of insertion of the sclero-corneal suture. A very narrow flap is fashioned along the limbus by the cataract knife as it emerges in between the two lips of the sutures. As this is a preplaced . .selero-corneal suture applied in a line at 12 o'clock position at the limbus it closes he corneal wound firmly and securely. It also takes less time than the other types of sclero-corneal sutures, and is very easy to apply. Additional sutures may be applied similarly at II o'clock and I o'clock positions if desired.
[Figure - 1]